The use of enteral feeding tubes which supply nutritional requirements of a patient directly to the stomach or other location in the digestive tract is often required when the patient for one reason or another cannot swallow, is unable to chew his or her food, or is unable to ingest enough food to meet the body's caloric requirements. Burn victims, the chronically ill, those inflicted with Alzheimer's disease and cancer patients are prime examples of these types of individuals. Enteral feeding usually employs a nasogastric tube to transport the liquid nutritional products through the nasal cavity and pharayrx and into the stomach.
Gastrostomy tubes may either be placed through the surgical creation of an ostomy while the patient is under general anesthesia or by means of percutaneous endoscopic gastrostomy (PEG) which involves a non-invasive creation of an opening or stoma in the stomach through the abdominal wall. The endoscope is passed down the throat until its terminus contacts the interior of the stomach. A needle with a stylet is inserted into the stomach wall until it passes therethrough. The stylet of the needle is retracted and a guidewire inserted through the cannula of the needle.
Using an endoscope, the end of the guidewire is grasped and pulled up through the throat. A permanent or primary gastrostomy tube is then put in place with its terminus within the stomach so as to form a direct enteral feeding conduit to the gastric system of the patient. However, there are often instances in which it is preferable to introduce the patient's nutritional requirements in the form of a liquid formula to the jejunum portion of the small intestine rather than the stomach. Some patients for example, when fed directly to the stomach, encounter a problem with such delivery known as reflux. In reflux, digested gastric residue is vomited up out the stomach and into the esophagus. Chronically ill or bed-ridden patients who are unable to swallow normally may inhale the gastric reflux inadvertently into the lungs resulting in asphyxiation or pneumonia. The tube itself can be forced out of the stomach as well. These situations in particular call for jejunal delivery of the nutritional formula.
It has been found in these instances that more efficatious feeding can be achieved if the feeding tube is passed through the pyloric area, and formula is passed directly into the patient's small intestine, rather than the patient's stomach. It has been further noted that when the feeding tube is installed so that the distal end is past the patient's pyloric valve, the tendency for the tube to be refluxed up to the esophagus is significantly reduced.
The jejunal feeding tube is introduced either through a surgically created ostomy or through the nasopharynxal passageway and passes through the stomach, the pylorus and then enters the small bowel, the duodenum and jejunum. Generally, with the patient sedated under general anesthesia, the surgeon guides the distal end of the tube through an ostomy to the jejunum. The lubricous and slippery environment of the lower abdomen however, makes grasping and manipulating the otherwise smooth and flexible tube considerably difficult.
U.S. Pat. No. 5,098,378 to Piontek et al. discloses and claims a replacement gastrostomy tube for jejunal feeding in which an expandable component of the tube is located at the distal end thereof. Fluid is passed through a fluid flow channel which enters the expandable component and inflates it like a balloon. In this fashion, the balloon and an adjacent retention device are pressed against the wall of the stomach, securing the feeding tube in the stoma.
U.S. Pat. No. 5,152,756 to Quinn et al. discloses an improved enteral feeding tube in which a bulbous extension member is attached to the distal end of the feeding tube. The extension is comprised of a stem portion that projects beyond the end of the tube parallel to the axis of the tube and forms a large spherical tip at its end. In this manner, the stem extension can be more easily grasped by forceps for surgical placement.
U.S. Pat. No. 5,100,384 to McBrian et al. discloses a device for percutaneous intubation in which the feeding tube comprises an inflatable lumen that expands as a water swellable foam material contained therein absorbs water from the gastro-intestinal cavity after intubation. A wire or suture loop is disposed at the terminal end of the feeding tube lumen for attachment to a wire used in pulling the tube through the esophagus and stomach during the intubation procedure.
U.S. Pat. No. 5,037,387 also to Quinn et al. discloses a method for positioning an enteral feeding tube within a patient's body and a tube for use therein comprising a flexible polyurethane tube and a rigid stem portion at the distal end thereof that forms an outlet from which the nutritional fluid flows. The stem itself ends in a spherical tip or ring which prevents the possibility of a puncture of the gastro-intestinal tract as the enteral feeding tube is pulled.
None of these prior art gastrostomy tubes provide an easy and effective means to enable the surgeon to quickly and safely place the end of the tube within the jejunum. Moreover, none of the prior art methods or devices allow the surgeon to safely locate and grasp the distal end of the feeding tube without posing a risk of injury to the organ walls and fascia. Nothing suggests a means whereby despite the slippery and lubricous environment of the gastro-intestinal tract, the tube can be firmly grasped and directed into the jejunum without the risk of getting caught within the pyloric valve or duodenum.